Ask the Biller Archives

We started an Ask the Biller Archives. We had to move some of our older "Ask the Biller" questions
to another page. It was just getting too big. Here are questions and answers from July 25, 2005 to
May 15, 2007

Question for Ask the Biller: May 15, 2007The physician I work for in Washington
state is not a participating provider with any insurance companies. We are
a fee for service office. Why would he need a NPI number? I have had other
offices call us to provide an NPI for him to be able to refer a patient to
another doctor. They say that they cannot get paid by insurance unless
they have my doctor’s NPI number. Thanks in
advance.Charlyn

Response from Ask the Biller:Hi CharlynThey are correct.
If your doctor refers any of his patients to another provider, they will
need his NPI number to get reimbursed, depending on the insurance carrier
of the patient. Eventually, all carriers will require it. So even though
you are a fee-for-service office, other providers will not be able to
accept referrals from you without an NPI number. They are free, and fairly
easy to obtain. The application only takes about 15 – 20 minutes. You can
fill out the application on line at:NPI online application.

Michele

Question for Ask the Biller:
May 14, 2007I only have 2 questions.Iam
a massage therapist.Do I need a NPI number and why?As this is getting very frustrating.One person says
yes and another says no.Thanks Alan T

Response
from Ask the Biller:Hi Alan,There is still some confusion over whether certain
providers need to have an NPI # or not, and LMT’s are one of them. If you
contact the NPI enumerator they can’t even tell you. There is not a
specific taxonomy code for LMT’s but they tell you to use the one that is
under Other Taxonomy, then pick Specialist. If you are billing insurances
then it is a good idea to have one, even though the NPI numbers are not
required yet by Workers Comp or No-Fault. Bottom line, the NPI numbers are
free, and it’s better to be safe than sorry. If I were you I would get
one.

Here is the link
for the online application:NPI online
application.We also offer the service of applying for you if you
would like. We charge $29.95 for the service. You can contact us by
calling 1-800-490-4299 between 8AM - 4 PM EST Monday - Friday.Good Luck,Michele

Question for Ask the Biller:
May 14, 2007Hi,What box(s) should the
NPI number go in? Thank You. Elly D

Response from Ask the Biller:Hi Elly,Where the NPI number
goes depends on if you are using the old HCFA 1500 or the new CMS 1500.
On the new CMS 1500 form the NPI goes in box 24J,
32A & 33A.On the old HCFA 1500, there isn’t a
specific place on the form, but some insurance carriers are having
providers put it in box 19.

Michele

Question for Ask the Biller: May 10, 2007I am very new to medical billing. When I get an EOB
which doesn't pay, but applies the amount to the patient's deductible,
what are the legalities of adjusting that bill for the patient? We charge
a lower amount for cash patients, so the person who has insurance would be
paying us more in this case. Is it legal to adjust this amount or do we
need to charge the amount that the insurance applied to their
deductible?Thanks,Kelly
W.

Response from Ask the Biller:Hi Kelly, Legally, a provider must bill a patient for
any amount applied to his/her deductible and copay. It is usually spelled
out in the provider’s contract with the insurance company. If an insurance
company gets word that a provider is not billing patient’s for their
deductibles, they can terminate the provider’s contract. However, there
are some ways around it. Laws vary from state to state so I can’t speak
for certain where you are located, but a provider can offer a discount if
there is ‘financial hardship’. Michele

Question for Ask the Biller: May 10, 2007DEAR SIR OR MADAM:I AM A
PHYSICIAN WORKING FOR A NON-PROFIT CORPORATION. I DON'T BILL FOR ANY
SERVICES MYSELF. THE CORPORATION GOT AN NPI NUMBER, BUT I DID NOT GET ONE.
A PHARMACY CALLED TO GET MY NPI NUMBER TO FILL THE PRESCRIPTION. DO I NEED
TO GET AN NPI NUMBER? IF I DO, DO I HAVE A CHOICE TO GET MY OWN OR DO I
NEED TO GET ONE ASSOCIATED WITH THE EMPLOYER NUMBER, SUCH AS WITH
MEDICAID? I DO PLAN ON DOING SOME PRIVATE PATIENTS IN THE FUTURE. DOES
THAT MAKE A DIFFERENCE IN THE WAY TO APPROACH THIS?SINCERELY,JOSEPH L

Response from Ask the Biller:Hi Dr. LEven though you are
not billing for any services yourself, you do need an NPI number as a
referring Dr and as a prescribing Dr. They are free, and easy to obtain.
You will definitely need one when you do see private patients to get
reimbursed by insurance carriers. If you go to our website,www.solutions-medical-billing.com and click on NPI
number on the left side, then scroll down to the bottom, there is a direct
link to the website’s online application. If you have trouble finding it,
please let me know. If you do not want to complete the application, we
offer a service to do the application for you for $29.95. It only takes us
about 5 minutes to do, and you usually get your NPI number within 24-48
hours.Michele

Question for Ask the Biller: May 6, 2007Hi Alice,What is an easy way
to register your NPI with hundreds of health insurance companies out
there? Thanks.Satish

Response from Ask the Biller:Hi Satish,Not sure there is
an easy way. Start using the NPI# on your claims. Medicare will forward
them to the crossover carriers. Some companies are asking you to log onto
their website and report them. Make sure when you send your claims you use
both the legacy numbers and the new NPI number. This should help.Alice

Question for Ask the Biller: May 3, 2007We want to know how do we provide our
NPI number to all the payers we bill medical claims.Noemi M

Response from Ask the Biller:Hi Noemi,Each insurance
carrier seems to be handling it differently. Some insurance carriers are
requesting that you sign into their website and enter your NPI. Some are
asking for your NPI when you call for claim status. A few are calling
offices and asking for them. Some are sending letters asking you to fax
back the info. If you get a request from a company for the NPI to be
submitted in a certain way, we suggest you do that.

We applied for NPI numbers
for all of the providers we work with and put them all on a spreadsheet.
We then faxed the spreadsheet to all the major insurance carriers. A
couple of companies have asked us to enter the NPI’s on their website.

When you file your insurance
claims, make sure that you are submitting both the old legacy # and the
NPI number. That will leave less room for error. Alice

Question for Ask the Biller:May 1, 2007PLEASE EXPLAIN WHEN AN A3 AND OR A2 VALUE CODE SHOULD
BE USED IN BLOCK 39 OF THE UB. MY MOTOR VEHICLE INSURANCE WHO WAS PRIMARY
DENIED THE HOSPITAL BILL. THE HOSPITAL BILLED MY SECOND INSURANCE WITH A
VALUE CODE A2 WITH TOTAL AMOUNT OF THE BILL. SHOULD THE HOSPITAL HAVE
BILLED MY SECOND INSURANCE WITH VALUE CODE A3 OR A2 PLEASE ADVISE SO MY
BILL CAN GET PAID.THANKING YOU IN ADVANCE ANNA M

Response from Ask the Biller:Hi Anna,The A2 Value Code is
used to indicate the amount to be applied to the patient’s co-insurance
for the indicated payor. This does not sound like the appropriate code for
what you are describing. The A3 Value Code is used to indicate the amount
estimated by the hospital to be paid by the indicated payor. This sounds
like it might be the appropriate code for this situation. But my question
is why is the motor vehicle insurance not paying the bill, and if they are
not paying it for an appropriate reason, is the hospital attaching their
reason for denial to the UB? I would think that would be more likely the
reason that your secondary insurance company is denying the claims.Good luckMichele

Question for Ask the
Biller:May 1, 2007Good Afternoon Alice, My
name is Lakisha S. I was looking at your website about Medical Billing and
I am interested in starting a Medical Billing Business from home. At the
present time, I am working for a Global Insurance company in Washington. I
have worked in the Medical field for 10 years now. I am currently
reviewing medical terminology as well as Medical Insurance information.
However, I still have a few questions: 1. How do
I market my business? 2. How do I gain the trust
from Doctors? 3. What are the Doctors look for
when they are searching for a biller? 4. How much
can I expect to earn starting out? 5. How do I
set up a contract between the Doctor and Myself? I know that I have a lot of questions, it's just that
I am 29 years old and my husband and I are looking to start a family very
soon. As you know, the price for child care is ridiculous! I look forward
to hearing from you and thanks for your help. Lakisha

Response from Ask the Biller: Hi Lakisha, Congratulations
on wanting to work from home while you start your family. This is what
Michele did, too.

You will find this is the hardest part of getting
your business started. You do have to gain the trust of the doctors and
this isn’t always easy if they don’t know you. Generally speaking when the
doctors are looking for a medical biller, they are looking for someone
they can trust to collect all the money they deserve for their services.
He or she is going to want to hire a person who is detail oriented and
experienced. Your ten years experience in the medical field will help.

Unfortunately you can’t
expect to earn a lot of money when first starting out. You need to be
billing for some doctors before the money starts coming in. It took us
awhile before we earned regular paychecks. We also wrote a book
“How to Start Your Own Successful Medical Billing
Business”which would help to
answer many of your questions.

Best of luck to you.Alice

Question for Ask the
Biller:April 24, 2007My
wife had our baby and some routine tests were performed in the
hospital. The insurance company said they don't have a problem with
the procedures, but that they will not pay because the claims were filed
with "Modifier 26". The pathology service said they can't file the
claims without the modifier 26 or else it could be considered fraud.
Any suggestions?Raymond
F

Response from Ask the Biller:Hi Raymond,The modifier 26
indicates that the provider, the pathology service, only performed part of
the test (the professional part). The provider that performed the
other portion of the test (or the technical part) would bill with a "TC"
modifier.

So the
pathology service is correct when they say they can't rebill it without
the 26 modifier since they didn't perform the entire test.

I've never seen an insurance
company refuse to pay a service due to the 26 modifier. Did you call
the company yourself? I would recommend that you call back and ask
again. It is unfortunate, but there are many insurance companies
with phone representatives that really don't know what they are talking
about. My first instinct is that this is a bogus answer. If
you receive the same answer on the second call, I would ask them what your
appeal rights are and I would file an appeal. If they would pay a
provider for the full test they certainly should pay for each component
separately.

If you don't
get anywhere with a phone call and your insurance is through an employer,
I would recommend going to your human resources department. They may
be able to help you since they are the ones paying the insurance
company.

Congratulations
on the baby!Good luck,Michele

Question for Ask the Biller:April 16, 2007Do
Ambulatory Surgical Facilities need a NPI? Of course the doctors who
perform surgery and anesthesia each have their own NPI but I want to make
sure a facility doesn't need one. Thanks for your help.Nancy

Response from Ask the Biller:Hi NancyYes, the Ambulatory
Surgery Center must apply for an NPI number also. You would apply
for a group NPI number for the Surgery Center. If you bill for
services in the name of the Ambulatory Surgery Center with the Center's
tax id# then you must have a separate NPI number for that center.
Better safe than sorry. It only takes a few minutes and is free.Michele

Question for Ask the Biller:April 16, 2007I have been seeing a chiropractor since Nov of
2006. My deductible with my insurance is $500 and after my
deductible is met my insurance pays 70% and I am responsible for the
30%. I have noticed that before my deductible was met my office
visits would be $30. Now that I have met my deductible they charge
me anywhere between $75 and $95 per visit. I have to pay 30% of
this. On the insurance statements I receive the chiropractor's
office is only billing my insurance $30 for each and it states I owe the
doc's office $9. But I always end up paying around 428.50 to $35 per
visit. Is this legal?

Response from Ask the
Biller:Hi Without seeing
your eobs (statements from the insurance company) it's difficult to say
what's going on here. What you need to know is if the doctor is
participating with your insurance. If he does participate, he can
only charge you what the insurance carrier allows. If you have a
good relationship with your chiropractor's office, go in and ask why you
are being billed so much. Ask them to explain it to you. If
they don't participate with your insurance, you may wish to go to a
chiropractor who does participate.Please let us
know what you find out. We may be able to help you further.Alice

Question for Ask the Biller:April 11, 2007I recently took the CPC, CPC-H
exams (last weekend). I am positive I passed them. My
problem now is what to do with them. I know I want to work form home
but have never worked in the field before. Coding is what I
want to do, but reading your website I am getting the impression that I
need a more global knowledge and training in billing. The school I
attended for a year online was pretty specific to coding and very little
about the actual billing process. Would your book be of assistance
to me in this endeavor - to primarily just code? Does it show how to
in detail what is needed to start a home based medical coding
business. A little direction in what direction I should go would be
extremely helpful. I am planning to also take the CCS and CCS-P
Tests this June. Thank you for your time and attention.Glenn L.

Response from Ask the Biller:Hi Glenn,Congratulations on
taking the courses and knowing you did well on the tests. I don't
know of any work at home jobs that only involve coding. Hospitals
and very large medical practices hire coders, but unfortunately I'm not
aware of any at home coders. Our book we offer "How to Start Your
Own Successful Medical Billing Business" was written for all the people
who come to us asking how to get their medical billing business
started. We write about what it actually takes to get a medical
billing service going. There's little about coding in our book.Medical billing is much more involved than
coding. If you decide to go that way, you will need more
education. I don't want to discourage you as we started our business
so my daughter could work from home while she raised her kids. Our
office is located on property at my home and we love it.Good luck,Alice

Question for Ask
the Biller:April 11, 2007I need to know what Place of Service cods Anthem
recognizes in box 24b. I have sent claims in with "3" for office
visit. I have also sent some "11" for office visit. Which
place of service code should I be using? Also, in field 33 where am
I supposed to place my anthem id#? I work for a general medical
physician in Kentucky.Shelly
T

Response from Ask the Biller:Hi Shelly,The correct place
of service code for services in the office is "11". The "3" is a
very old code that is no longer used. Your Anthem ID# or Pin on the
old HCFA form should go in box 33 at the bottom of the box where it says
PIN. On the new CMS 1500 forms it would go in the same box, but over
to the right further in box 33b.

We are now working on a video we will soon be
offering on how to complete the new CMS 1500 forms. Let us know if
you would be interested. We're going to offer them for general
billing as well as medical specialties such as vision, mental health,
physical therapy, surgery, chiropractic, etc. Michele

Question for Ask the Biller:April 5, 2007We are about to use the new HCFA 1500
form. In box 24 can the service be in the red line or must it be in
the white line?Sue

Response from Ask the Biller:Hi Sue,In box 24 the service
should print on the white line.Alice

Question for Ask the Biller:April 4, 2007I
work for an internist in California who recently started visiting patients
in board & care homes. We have been getting paid by Medicare for
codes 9932x and 9933x using place of service code 13, assisted living
but rejected by MediCal. What is the correct pos code - 33
(custodial care)?

Response
from Ask the Biller:Hi I
assume that MediCal is your Ca. Medicaid. Each state has different
requirements. We have found that calling the company involved, in
this case MediCal, and asking what they require will usually get you the
right answer.Alice

Question for Ask the Biller:April 4, 2007

Is
there a website to look up providers' NPI numbers?Pam B

Response
from Ask the Biller:Hi Pam,Sorry there is no website to look up NPI
numbers. It would probably be a security nightmare as far as
confidentiality.Alice

Question for Ask the
Biller:April 2, 2007

We don't want to use pre-printed HCFA 1500 forms and
were wondering if we simply printed the identical information on a plain
piece of paper (black and white) if that would be ok?

If this is ok, do we have to
include the legal jargon on the back of the pre-printed HCFA 1500 forms on
the forms we create?

Thanks for your help.Nancy
W.

Response from Ask the Biller:Hi Nancy,Many insurance
companies scan paper claims. When they scan them, the red
print on the HCFA forms is important to the scanning process.
When you print the form as well as the claim information and it is all in
black and white, the forms will not scan properly and may be returned to
you. The legal jargon on the back is not important to the claim
payment process so it wouldn't matter, but the red lines and boxes on the
claim forms do matter. Sorry I didn't have better news for you.Alice

Question for
Ask the Biller:March 26, 2007I hope
you can help me. We have always sent our UB92s for our Ambulatory
Surgery Center on paper claims. We are trying to convert to sending
them electronically. They are not being accepted by the clearing
house because there is no condition code on the claim. We have never
put a condition code on the paper claims and have always received
payment. We are an ophthalmology practice that routinely bills for
cataract surgeries. I have purchased the Uniform Billing Editor and
have reviewed the condition codes and do not see one that seems to apply
to us. Can you please help me?Thanks,Cindy

Response from Ask the Biller:Hi Cindy,I also looked at
all the condition codes and don't see one applicable. I have never
personally been required to complete that field either on my paper claims
or my electronics. There must be a code that you can automatically
put into the electronic claims to get them to go thru that actually won't
affect the billing. I would contact the support line for the
clearing house that you are using and ask them. Often there are
requirements by the clearing house that the insurance carriers don't
necessarily set. They certainly should be able to tell you what you
can use to get the claims thru. Explain to them that you don't need
a condition code on the claim and that there is no appropriate code that
you can use.There are obviously other providers
that use the clearing house with the same issue and they must have a
generic value you can enter.Do you go directly to
a clearing house or do you have a vendor? If you have a vendor, you
should contact them first. They will be more helpful. If you
don't get anywhere, email me back with more specifics. What state
are you in? What clearing house, etc.Good
luck,Michele

Thanks so much for the
information. I feel so much better knowing that you also could not
find an applicable condition code. We are in the state of Georgia
and our software vender uses Mckesson as the clearing house. I will
have our software vendor contact the clearing house for this
information.Thanks so much,Cindy

Question for Ask the Biller:March 26, 2007How do I know whether to use UB form (UB92) or
HCFA/CMS form? Many thanks,Satish

Response from Ask the Biller:Hi Satish,Usually the
insurance carrier determines whether you need to bill on a UB or a HCFA by
how they have you classified in their provider file. Hospitals and
facilities generally bill on UB92 (UB04s now). Physicians bill on
HCFAs (CMSs now). When we bill for a facility, we call each
insurance company and get the provider representative and ask which form
they want us to bill on. Generally it is the UB, but a few have told
us to use the HCFA. You can call each company and explain your
situation and ask them which form they prefer. I hope this helps
you.Alice

Question for Ask the Biller:March 22, 2007I just signed up today for your newsletter and
already I have a question for you.

We billed an insurance company for a patient that had
services twice in the same day for different diagnosis. Is there a
modifier that we can append to the claim to notify the insurance carrier
that this claim is a separate claim?Thanks,Sandy H

Response from Ask the Biller:Hi Sandy,I need a little
more information before I can reply to your question. What are the
services the patient received? Are you billing the same insurance
for all services? For example, you can't bill the same insurance for
2 E&M codes on the same day unless the patient returned to the office
later on the same day. But if the patient has a workers' comp case
and you are seeing the patient for the work injury and other unrelated
reasons, then you can bill an office visit to both insurances.
However, if the patient had an office visit for bronchitis and had
incision and drainage for a cyst, then you can bill both services using
the appropriate diagnosis with each claim line and using a 25 modifier on
the office visit line to indicate the office visit was "separately
identifiable E&M service by the same physician on the dame day".
There is another modifier, 59 which states "Distinct Procedural
Service."

If none of
these examples pertains to your situation, email me with more
specifics! Hope this helps.Michele

Question for Ask the Biller:March 10, 2007I was wondering if there is a page that I can access
to obtain NPI numbers for physicians. I work at St Margaret Mercy
Health Care Centers and we are currently working to obtain all the NPI
numbers for our physicians. We are finding that when we call the
physician's offices that they request for us to send a letterhead with our
request. This can be quite time consuming. I was looking for
an easier way. If you could please assist with this matter I would
greatly appreciate it.Cheri M

Response from Ask the Biller:Hi Cheri,Because NPI numbers are confidential information, we
are unable to obtain someone else's NPI number without asking them
directly for it. We've found the best way to handle this need for
the individual NPI number is to write a form letter asking for the NPI
number on your letterhead. You can even briefly explain the need for
it so the doctor’s office staff is more likely to act quickly on it.
These can be photocopied or printed out on the letterhead and a copy sent
to each of the doctors. You can also store the form letter in a word
processing program in your computer and quickly type in the name and
address of each provider if you feel there is a need to make it more
personal. If your biggest concern is saving time I recommend
photocopying the form letter on your letterhead and having a stack of them
ready to send as you need them. Hope this
helps.Alice

Question for Ask the Biller:March 6, 2007Do you need a NPI number if you are not
a Medicare provider and do not accept insurance? Will you need it to
order lab work?Thanks,Bob G

Response from Ask the Biller:Hi Bob,I would suggest that
even if you are not a Medicare provider or even a provider who accepts
insurance to obtain a NPI number anyway for a couple of reasons. 1. The law states that ALL health care
providers must obtain a NPI number. The penalty for not getting one
is non payment of claims which will not affect a provider who does not
accept insurances, but the law states you must have one.2. They are free and relatively easy to
obtain.The lack of a NPI number most likely
will interfere with other activities that the provider does, such as
ordering lab work or referring a patient to another
provider/specialist. You can get to the application form at
NPI Number
at the bottom of the NPI page.Michele

Question for Ask the
Biller:March 5, 2007I am
quite excited to find you. My husband is a Chiropractor in Pa.
We use HCFA and now CMS 1500 forms. Our software is Medisoft.
I cannot get the answer to many questions I have. Which NPI number
goes where? We have one for group and one for
individual. I believe this is box 33 on the new form.Big question - I work for a durable medical equipment
company that only submits to auto and workers comp. Does this
provider need an NPI? They are not a dr and it is all paper - no
health insurance.Thanks so much for your help.
Marcy M

Response from Ask the Biller:The group NPI number goes in box 32A and the
individual NPI number goes in box 33A. Yes,
the DME company should apply for an NPI number also. Even though
they aren't a Dr., they are a health care provider. Many of the WC
and NF companies may not be indicating that they require the NPI number to
continue reimbursing, but as the law states, all health care provider's
are required to obtain a NPI number.Since there
is no cost involved in getting one, I would strongly recommend that they
get an NPI number asap. There is no downside to getting one and a
big downside to NOT getting one and then needing it!!Thanks and good luck,Michele

Question for Ask the Biller:February 27, 2007Hello, As of 2007, we have
been receiving denials from United Healthcare for CPT codes 97010 (Hot
Packs) and 97014 (Unattended Electrical Stimulation). They are
telling us that these are bundled services. I can't find any
information as to which CPT code they should be bundled with. The
only other charge we do per visit is the Spinal Manipulation code of
98940. Do you happen to know the answer to this? All the above
services are provided by a licensed Chiropractor. There is not a
Physical Therapist on staff. We have never had a problem up until
this year.Thank you in advance for your help!Rebecca

Response from Ask the Biller:Our providers are not having any problem with UHC
processing their claims for 2007. They are not "bundling" the 97010
or the 97014 in with anything. We do work with other insurance
companies that bundle these two codes in with the manipulation code but
that is because they have a "global fee" for chiropractors. The other thought that I had was - are the UHC
plans that are denying codes in specific groups? Or is it all UHC
across the board? We have a large UHC plan here called Empire, but
it is processed by UHC. They have their own set of rules and don't
have to go by UHC rules.Have you tried to call
UHC and ask why the claims are being processed differently? If you
have a specific patient that had a visit in 2006 and in 2007 that were
processed differently, I would call and ask someone to explain it to
you. You might even want to contact your UHC provider rep for your
area. They may be able to help. It may be a problem with their
processing system that needs to be addressed.Good
luck.Michele

Question for Ask the Biller:February 26, 2007Is there any way we could get a few samples of the
new UB04 form?Robin

Response from Ask the
Biller:

Hi Robin,I don't have
any of the UB04's yet myself. I'd be glad to send you a few.
We've been sending all our UB04's electronically so I haven't had to
purchase any forms yet. But you can find a form and instructions at
this link. http://www.ibx.com/pdfs/providers/npi/ub04_form.pdf
Alice

Question for Ask the Biller:February 15, 2007I
need help with UB92 claim forms. I am new to the psychology
field. I have been sending UB92 claim forms to Blue Cross of
California and I keep getting the following comments sent back, "please
resubmit claim with correct type of bill." I have been using 131 -
not sure if that is correct. The codes we use for billing are "0913
for adult/child disorder full partial day" and the other code is "913
Psych/Partial Intensive." 912 Psych Partial Hosp/PHP. I have
called and spoke directly to a supervisor and she mentioned that she did
not see a problem. The other thing I found out was that 131 each number
gives three specific pieces of information. The first digit of the 3
denotes the type of facility, the second digit classifies the type of care
being billed, and the third digit identifies the sequence of this bill for
a specific episode of care... Not sure where I could get a list of
definitions and guidelines for this problem I am having...?Ester

Response from Ask the Biller:Dear Ester,You are correct
with the information that you have regarding the 3 digits of the type of
bill field. Do you have access to a UB92 Editor (book)? It would be
very helpful to you in this situation. It breaks down the UB92 by
field and explains each in detail. Based on what you told me in your
email it looks like your type of bill, 131 is indicating hospital (1st
digit) outpatient (2nd digit), admit-through-discharge claim (3rd
digit). I can't quite tell by the information that you gave me if
that is accurate, but if it is not, please email me back with more
specifics and also which portion you feel is not accurate. I can try
to help you find the right code.Michele

Question for Ask the
Biller:February 15, 2007I just received my new preprinted HCFA 1500 forms and
on "24C Type of Service" has been replaced with emg. What is emg and
what do I put there? I can't find this info anywhere.Thank you soooo much

J Wells

Response from Ask the Biller:Dear J Wells,On the new CMS
1500 forms they no longer have a field for the type of service.
There is no longer a need to indicate the type of service at the claim
level. The EMG field that replaced it is only if the service is
related to whether or not it was an Emergency. Most insurance companies do not require this
field to be completed and it should be left blank. This field was
already on the old HCFA 1500, but it was box 24I. If you weren't
using it before, you don't need to worry about it now. Just leave it
blank!Hope that is helpful.Alice

Question for Ask the Biller:January 25, 2007What fields do I need to fill out on a UB92 for Home
Health? Also, I am looking into becoming a certified coder for all
specialties. Who offers this in Virginia? Can I take this
course online? Thank you.Sharon B.

Response from Ask the Biller:Dear Sharon,The required
fields on the UB92 vary from insurance carrier to carrier. I can
recommend a great resource for you which will detail field by field the
requirements for your specialty. It is the UB92 Editor and can be
purchased from Ingenix at http://ingenix.comI did a quick search
and it does look like you can become a certified coder with an online
course. I did a Google search for "certified coding specialist Va"
and several options came up. I would suggest that you look into them
to see what is best for your circumstances.Good luck,Alice

Question for Ask the Biller: January 02,2007
Dear Alice,You
have helped me once before with the UB92 form and I hope you can answer
another question. One of our insurance companies is not accepting
049x (ambulatory surgical care) in box 42. I have reviewed the other
choices listed in the manual and also from information listed on the
Empire Medicare Website and the 049x appears to be our best choice.We have been accredited as an Ambulatory Surgical
Facility and therefore 049x seems very appropriate. I would
appreciate your help. Thank you,Nancy
O

Response from Ask the Biller:Dear Nancy,If the 049x is
the best choice for your facility and the other insurances are accepting
it, I would recommend contacting the company that is not accepting it and
speaking to your provider representative. (Most of the larger
insurance companies have a designated provider rep for the doctors to
contact with problems.) They should be able to help you out with1.) Why do they not accept the 049x (which is
accepted by most others)?2.) What will they
accept that still describes your facility?

Each insurance company has different claims
processing systems and this company may need to change their system to
allow for the 049x code. Bringing it to the attention of the
provider rep may help straighten it out.Hope this
helps.Alice

Question for
Ask the Biller:December 19, 2006Hi,I went to
my general physician and had a full battery of blood tests back in May
because I had a rash or an allergic reaction. I also had not had a blood
test for years. Anyway, the results showed that I had Hypothyroidism. My
GP wanted to put me on Synthroid but I felt that I should see a specialist
(Endocrinologist). I went to the Endocrinologist with my blood results and
he also stated that I would need to be put on Synthroid. I decided at this
point that I will follow his conclusion and I started taking medication.
Several months later, I went for more blood tests to see how my levels
looked. I also thought that I would go to another Endocrinologist for a
second opinion, who was also closer to where I live. Not to mention I was
not thrilled with the first Endocrinologist. I went to the second End.
with recent blood work and she reviewed it and suggested that the amount
of Synthroid needed to be lowered. She wrote me a prescription and a
filled it. I set an appointment for a follow-up visit with her to check my
levels again. A day before my scheduled visit, my Explanation of Benefits
came from my insurance company. I owed $350.00 for the "Consultation" that
the 2nd Endocrinologist gave me. I called the insurance company, United
Health Care in New York, and they explained that my plan only covers one
consultation per year, per specialized area for the same issue. I tried to
explain to the insurance co. that this was a second opinion but they said
that the Dr. billed it as a consultation. I went to my appointment with
the Dr. and talked to them about the bill. I explained to the billing
manager that the previous visit was a second opinion and that the
insurance company said they would pay for it if it were billed that way.
The billing manager got nasty and told me that they cannot change how it
was billed to the insurance company because it would be fraud. Now I am
responsible for paying $350.00 because of what I believe was a clerical
error on the Dr.'s part. What do I do?? What is the difference between a
consultation, a second opinion and an office visit? Should I pay the Dr.
of try to fight this? I don't want this going to collections.

Response from Ask the Biller:Hi, This is a messy situation. It is
true that UHC doesn’t cover more than one consultation per year for a
specialty. As far as the billing manager getting nasty, that’s
unfortunate. It isn’t fraud to change what was billed to an insurance
company if the original billing was incorrect. I personally don’t
understand why when you make an appointment to see a new doctor who is a
specialist it gets billed as a consultation as opposed to a new patient
exam. If the service was billed as a new patient exam, UHC would have paid
it. However, the allowance for a consultation is considerably higher than
it is for a new patient exam, which makes it clearer as to why the
provider bills it that way. Unfortunately, it is up to the doctor to
decide what service(s) they performed while with the patient. So you
really don’t have many options. If the billing manager states that the
service(s) were billed appropriately, then you cannot force her to change
them. However, she should be willing to work out something with you if she
had any hopes of you being a return patient. I’m not sure if you want to
continue seeing the doctor, but if you did, you may want to bring it up
directly to her. She may be interested to know how her billing manager is
treating her patients. Many times the doctors have no idea what is
happening on the business end, and they should. They never know that a
patient left because of dealings with their staff. I wish I could be more
helpful, but your options are limited. You may be responsible to pay the
whole amount. Good luck. Alice

Question for
Ask the Biller:November 9, 2006Hi my name is Cindy and we have had the same
insurance and used the same provider for the past 4 years. Until
recently we haven't had any billing problems. However, in the past
month we have had 4 claims rejected by our insurance company because the
doctor we supposedly saw was not a contracted provider with the
insurance company.

We
check in first and they accept our insurance and take our copay. We
are then seen by the doctor. One would assume that we should not
have to ask if that particular doctor is a contracted provider with our
insurance company. Well, come to find out, the doctor's office is
using one doctor's name to bill the insurance company regardless of which
doctor has been seen. The name of this doctor just happens to be the
doctor not covered by our insurance. Is this legal?

My insurance company tells
me that the claim they receive from the doctor's office is a legally
binding contract and therefore they cannot change it. Thank you in
advance to your response in this matter. I am seriously thinking
about talking to a lawyer about this issue.

Cindy

Response from Ask the Biller:Hi Cindy,We have been
advised by many insurance company representatives that it is illegal for a
doctor to bill for services performed by another doctor. It sounds
as if the provider is not billing correctly. I would think that your
insurance company would have a problem with the fact that your doctor sent
them a "legally binding contract" that is not accurate. I would start with your doctor's office. First
of all, do they have any signs stating that they are participating
providers with your insurance? Did they ever advise you that they
didn't participate? If they accept your insurance then they cannot
legally charge you for these services above the amount of your
copay. If they have been accepting your insurance right along and
they stopped, you should have been notified that they were no longer
accepting it.

Ask to talk
to the billing manager. You need to calmly explain that your
understanding is that the office accepts your insurance. If you
absolutely can't get anywhere with the office staff you need to contact
your insurance company and explain that you feel your doctor's office is
billing your insurance incorrectly. Tell the representative which
doctor it was who treated you. You are probably not the only patient
with this problem and the office staff needs to address it and fix the
problem.

A lawyer would
probably be an expensive way to go. If you don't get anywhere with
these suggestions, let us know.

Good luck,Alice

Question for Ask the Biller:
October 4, 2006Do you know the location the NPI# goes in on the
UB92?Paula L Chester County Healthcare Inc

Response from Ask the Biller:

The current UB92 does not have a specific location
for the NPI# so it will become obsolete in 2007. As of January 1, 2007 we
will be able to submit on the new replacement for the UB92 called the
UB04. The UB92s will no longer be accepted after April 2,
2007. Make sure your software and vendor can accommodate this
change.Alice

I have
a question about the UB92 form, revenue code box 42. We are an accredited
ambulatory surgery center so I have been using 049X as the revenue code.
Please let me know if this is the correct code.

Where could I find type of
service codes for our HCFA 1500 forms? I found the most recent place of
service codes in our CPT4 book but there is no mention of type of service
codes. Thanks for your help.Nancy O

Response from Ask the Biller: On your question on
the UB92 forms, my experience has been that they vary between insurance
carriers. We call each insurance company and ask which rev codes were
appropriate to our situation. They were very helpful. If they are paying
with the 049X, it must be correct.

We found a chart of the type of service codes at the
Blue Cross website. I would provide a link, but it is a secure site with a
sign in. If there is a particular code you need and can't find the chart,
let me know and I'll look it up for you. AliceQuestion for Ask the Biller:October 10, 2006

Hi Alice,Thanks very much for the information.
We are not participating with BC so I cannot sign in. I would like to find
out the type of service codes for Consultation, Surgery, Anesthesia, and
Facility.Nancy O

Response from Ask
the Biller:

Hi
Nancy,

I just checked
the BC website and Anesthesia is 7, Consultation is 3, Surgery is 2, and
Facility for ambulatory surgery is F. Glad we could be of help.Alice

Response from Ask the Biller:

Question for Ask the
Biller:September 25, 2006

Question for Ask
the Biller:September 19, 2006

I was wondering if there is any way of
finding out the UB92 code that was sent from the hospital to the insurance
company. I am having a problem with the bill from the insurance agency not
paying their portion of the bill. They state that the patient did not pass
away with cancer although this is listed on the death certificate. The
patient, my aunt, also carried a cancer policy with the insurance agency.
I need to find out the UB code that the hospital sent to the insurance
agency. Can you give me some advice please? I appreciate any information
you may give.

Thank you -
DD

Response from
Ask the Biller:First you need to call the hospital billing
department and tell them that your insurance company is denying your claim
due to the diagnosis code submitted. You need to know if they used a
cancer diagnosis when they submitted the UB92 to the insurance company. If
they did not use a cancer diagnosis, you need to ask why not. You should
also call your aunt's insurance company (the number is on the back of her
insurance card) and ask specifically why they did not pay this portion of
the bill. The representative may help you determine what else needs to be
done. Let me know if this helps or you need further assistance.Alice

Question for Ask the Biller:September 1, 2006

Do I have to
purchase claim billing software or could I just set up with a clearing
house? I'm just starting out.

Lee G

Response from Ask the Biller:

You must have practice management software to send
the information to the clearing house. That's how the clearing house gets
the information.

Alice

Question for Ask The
Biller:September 1, 2006

Alice

Question for Ask The Biller:

August 25, 2006Question for Ask the Biller

August 5,
2006

I received a bill from a Radiology
Group for $300 for a mammogram. They said my insurance company won't pay
for it. Do I have to pay this bill?

Jeanette T.

Response from Ask The Biller:Most insurance covers mammograms whether they are
routine or for a medical condition. In either case, you should contact
your insurance company and ask them why they didn't cover the charges. It
may be an error on their part, or the provider may not have billed the
charges correctly. If you have a deductible, the charges may have been
applied to that and you may be responsible. The phone number for your
insurance company should be on your insurance card.

Michele

Response to Advice from Ask the Biller:

Thank you so much for your advice. I
called my insurance company and they said that the charges were denied
incorrectly. They are reprocessing my claim and paying the bill in full!
I'm so glad I didn't pay it myself! Thanks again.

Jeanette T.

Question for Ask The
BillerJuly 25, 2006

I had to deal with a service that missed submitting a
bill of mine and because it was past the maximum time (in their contract)
the insurer refused payment. The billing service tried to bill me for the
entire bill. It was eventually turned over to a collection agency. After
three separate calls from my insurer, that bill was not billed to me and
the billing company actually returned $32.00 that I had over paid on
another charge. I haven't checked, but guess I'd better, make sure they
didn't report me to one of the credit bureaus as I was recently turned
down for credit and have an excellent credit rating and have almost no
credit card debt.

I can't
help but wonder how many other people had to put up with dunning letters
and phone calls. The caller from the collection agency was very kind but I
am sure he did not believe me as most businesses would not turn over a
bogus debt to collection.

Bonnie B

Response from Ask The Biller:The email is
accurate and it is an EXCELLENT example of a POOR billing service. The
billing service should not have billed that patient. If they missed
sending in her claim to the insurance company in a timely manner then they
should have been answering to the Dr as to why! If the Dr is contracted
with her insurance company it is ILLEGAL for them to bill the patient
because they missed the time filing limit.